2016 Open Enrollment

2016 – Benefits Highlights Benefits Administration: First Choice Health (medical, dental & vision) Pharmacy Benefits Administrator/Network: MedImpact FSA (Flexible Spending Account) Administration: HealthEquity 24 Hour Nurse Line Maternity Program No changes to medical benefits No new ID cards unless you make enrollment changes

Health Care Reform & the ASD plan: The ASD plan is considered Grandfathered, so certain Health Care

Reform provisions aren’t applicable to our medical plan, such as copays being required for Preventive Services and contraceptives.

2016 MEDICAL BENEFITS

Medical Plan – Definitions

Health benefits have a terminology all their own. As we discuss your benefits the following terms will be used frequently:

Deductible: A deductible is a portion of money that you pay before the plan begins to pay benefits. Your plan only has a deductible if you choose to go out of the provider network

Copay: A fee paid directly to a provider, facility or pharmacy at time of service.

Copays due accrue toward your annual out of pocket maximum.

Coinsurance: The portion of the bill you are responsible to pay.

Out of Pocket Maximum: caps your member responsibility for in-network services.

Prior Authorization: certain services require medical review in order to determine medical necessity. View the Prior Authorization listing at www.fchn.com or in your Open Enrollment Guide posted on the district website.

Medical Benefits – Plan Specifics

FCHA Network Out of Network

Deductible $0 $300 Individual$900 Family

Coinsurance 80% 50%

Office Visit 100% after $25 copay

50% after deductible

Preventive Office Visit

100% after $25 copay

50% after deductible

Emergency Room 80% after $100 copay(copay waived if admitted)

Inpatient Hospital 80% 50% after $250 copay per

confinement. Deductible applies.

What Happens When I?

FCHA Network Out of Network

Type of Service: You’ll Pay: You’ll Pay:

Need to go to the doctor…

$25 copay Deductible* & 50% of all additional charges

Am hospitalized… 20% of the cost up to the Out of Pocket Maximum

Deductible*, $250 per confinement copay & 50% of all additional charges

Visit the ER… $100 copay then 20% of the cost up to the Out Of Pocket Maximum

$100 copay then 20% of all additional charges

Get my annual exam…

$25 copay Deductible* & 50% of all additional charges

Have outpatient surgery…

20% of the cost up to the Out of Pocket Maximum

Deductible* & 50% of all additional charges

*Annual Deductible $300 Individual/$900 Family

How is Alternative Care Covered?

FCHA Network Out of Network

Type of Service: You’ll Pay: You’ll Pay:

Acupuncture

$25 copay$300 annual

deductible* & 50% of all additional charges

Chiropractic – 20 visit Limit /Calendar Year

Massage Therapy12 visit Limit /Calendar YearPrescription must be submitted with the claim.

Naturopathic Care*The annual deductible indicated is the overall medical plan

deductible.

2016 PRESCRIPTION BENEFITS

Prescription Benefit Highlights Local MedImpact Participating Pharmacies:

Ashland Drug

Bi-Mart

Rite Aid

Medicap

Pharmacy

Phoenix

Pharmacy

Savon

Wal-Mart

Fred Meyer

Walgreens

Safeway

90 day fills (Pharmacy & Mail Order): 90 day supply of your prescriptions are available at participating Choice90 pharmacies. You can also get a 90 day supply through the MedImpact mail order program.

Generic vs. Brand Name: Members pay the difference in cost between the brand and generic medication(s) anytime there is a genetic available and a brand name medication is chosen when your prescribing physician allows for a generic substitution.

Prescription Benefit Copays

30 Day Supply

90 Day Supply

(Choice90 retail)

90 Day Supply (mail order)

Generic $15 copay $45 copay $30 copay

Preferred Brand $30 copay $90 copay $60 copay

Non-Preferred Brand

$45 copay $135 copay $90 copayHow are specialty drugs (Copaxone, Embrel, etc.) covered by the plan?Specialty drugs are covered by the plan when obtained through the Diplomat Specialty Pharmacy. Specialty Drugs may require prior-authorization and/or have quantity limits. Copays for Specialty Drugs align with the Generic/Preferred/Non-Preferred copay tiers.

How are compound drugs covered by the plan?Compound drugs are covered by the plan at the applicable tier copay. Pre-Authorization is required for compound drug charges greater than $400.

Please keep in mind:If the cost of your drug is less than the tier copay you will pay the lower amount.

2016 DENTAL & VISION

2015 Dental Benefits

Annual Deductible $50 Individual$150 Family

(Waived for Preventive Services)

Annual Maximum $1,500 Per Covered Individual

Class A Expenses – Preventive & Diagnostic

100% of allowed amount

Class B Expenses – Basic Services (fillings, root scaling)*

80% of allowed amount

Class C Expenses - Major Services (crowns, dentures)*

50% of allowed amount

*Obtaining a benefits pre-determination is recommended prior to beginning extensive dental services.

2015 Vision Benefits

FCHA Network Out of Network

Annual Routine Vision Exam

100% 100% of allowed amount

Vision Hardware* 100% up to $350 per calendar year

Vision Hardware includes: Eyeglass lenses, frames, contact lenses and contact lens fitting.

*For those with vision hardware coverage.

SPECIAL PROGRAMS

24/7 Nurse Line & Health Information Library

Available around the clock to answer your health questions!

Have a sick child at 2 am? Unsure if you should go to the doctor or Emergency Room? Looking for an answer to a health question? Call the 24/7 Nurse Line to speak with a Registered Nurse who can

answer your health questions at no cost to you. You can also access the Health Information Library, with information on

over 1,500 health topics available in English & Spanish.

Maternity Management

For a healthy pregnancy and a healthy baby.

Available at no cost to you – even if you aren’t a first time mom!

One on one support from a Registered Nurse Regular telephone sessions with your nurse Sessions provide educational information and ways to minimize risks to

you and your baby Your nurse can assist you with managing your diet, exercise and other

ways to maintain a healthy pregnancy

ONLINE TOOLS

First Choice e-Tools

Did you know?

First Choice’s member website offers you the ability to access your plan and medical claim information online. Create an account to:

Find a provider (local or national) View enrollment status Print a temporary ID card/Order a new card Sign up for e-EOBs Review medical plan documents Review claims information & EOBs Email customer service Download forms

Please visit www.myFirstChoice.fchn.com

Landing Page

Eligibility & Benefits

Navigate here to: Update your email

address Verify your

eligibility Check your plan

deductible, out of pocket and other benefits

Order/view your ID card

Claims

Navigate here to: View claims Download

copies of EOBs

Move your claim history to an excel file via cut & paste

Filter by date, family member and claim type

Find a Provider

Navigate here to:

Search for providers in the First Choice Health Network

Search for providers in the First Health Network

Customer Service

Navigate here to:

Contact Customer Service

View forms: Claim HIPAA

Health Resources

Navigate here to:

View online Health Tools

Access Health Links

What YOU Need To Do – Wrapping Up

Everyone:

Complete the First Choice Health Enrollment Application – Not making any changes? No form required

Complete the Health Equity Enrollment Application for the FSA program – Even if you aren’t enrolling, we need your declination to participate on file

Complete Premium Withholding Form

Turn all forms in to Human Resources by November 30, 2015

.

2016 FLEXIBLE SPENDING ACCOUNT

When you choose to participate in the ASD Flexible Spending Account Program you can set aside pre-tax dollars to:

• Cover medical, dental or vision expenses not covered by your health plan.

• Pay for non-medical dependent care expenses.

2016 Contribution Limits:

$2,550 Healthcare FSA$5,000 Dependent Care FSA$300 Minimum Contribution

How an FSA Works

1. Sign Up Review your medical expenses for the last year and estimate

your expenses for 2016. Determine the amount you would like to contribute to your

FSA on a pre-tax basis2. Contribute

ASD will arrange to have the determined amount of your pre-tax earnings contributed to your FSA.

3. Use Your Funds When you incur a qualified expense, you can either pay with

the HealthEquity Visa debit card or submit the expenses through the HealthEquity online tool for reimbursement.

Save your receipts! You’ll need them to submit reimbursements or to validate debit card expenses.

Plan Wisely When Setting Aside FSA Funds

The FSA is a tax-preferred account and federal guidelines are very specific about what happens to funds that are not spent by the end of the plan year.

Healthcare FSA: Annual rollover of up to $500 is allowed You are eligible to roll funds over to the next year even if you

decide not to make additional contributions.Example: Lisa set aside $1,400 in 2014 for Healthcare

expenses. She spent $1,100. Lisa decides that she won’t contribute additional

funds to the FSA in 2015.Lisa has $300 that will roll over to the 2015 plan

year. Healthcare FSA accounts with a balance of more than $500

will forfeit amounts over $500Dependent Care FSA: No rollover is available. Unused contributions are forfeited.

Qualified FSA Expenses: Acupuncture Alcoholism Ambulance Amounts not covered

under another health plan

Annual physical examination

Artificial limbs/teeth Birth control

pills/prescription contraceptives

Body scans Breast reconstruction

surgery following mastectomy for cancer

Chiropractor

Contact lenses Crutches Dental treatments Eyeglasses/eye

surgery Hearing aids Long-term care

expenses Medicines

(prescribed, not imported

from other countries) Nursing home medical

care Nursing services Optometrist Orthodontia Oxygen

Stop-smoking programs

Surgery, other than unnecessary cosmetic surgery

Telephone equipment and repair for hearing-impaired

Therapy Transplants Weight-loss program

(if prescribed by a physician for a specific disease)

Wheelchairs Wigs (if prescribed)

Examples of Non-Qualified Expenses: Concierge services Diaper service Elective cosmetic

surgery Future medical care Hair transplants Non-prescribed

drugs Nutritional

supplements Health club

memberships Insurance Premiums

FSA Features

Convenient access Debit card Online -

http://healthequity.com/ HealthEquity free mobile app 24/7 telephone assistance

Use your HealthEquity account to Check your balance Review transactions Review claims Enroll in direct deposit

reimbursement Submit new claims or

documents Send payments and

reimbursements

• On-the-go access for all account types

• Take a photo of documentation with phone and link to claims and payments

• Ability to directly pay provider via online tools or request reimbursement from your FSA account

• Manage debit card transactions• View claims status

Mobile App Features

Available for iOS and Android